WELCOME TO SWANBOROUGH HOUSE OPERATIONAL GUIDELINES FOR PROVISION OF SERVICES
CONTENTS Welcome and Introduction to Renovo Care Group Page Introduction to Renovo 7 What can you expect? 8 Staff Training 10 Your feedback matters 11 Swanborough House Introduction to Swanborough House 13 Settling In 18 What we offer 19 Home comforts 20 Who’s who 21 Who wears what? 23 Activities 24 Events and outings 25 Out and about 26
CONTENTS Page Visitors 27 Meals 28 Language and communication support 29 Care and Therapy Our Care 31 Assessment 32 Goal setting 33 Reviews 35 Medication 37 Safety Infection Prevention & Control Safeguarding Adults 40 41 Fire Safety & EPRR 47 Notes 48 Introduction 39
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Welcome and Introduction to Renovo Care Group
Welcome to Renovo Care Group. We are committed to providing safe, effective care in good surroundings, ensuring the best possible experience while here. Our work is underpinned by our values. We are proud to : respond with Compassion, Respect everyone. We will be accountable for our actions and be proactive in the care we provide. Above all else we will do it to the absolute best of our ability. Determined to develop our skills and continuously improve the quality of care we want to deliver Care which is safe and enabling. This means discussing care plans with residents, their family, the doctors and nurses so the right decisions are made about the care provided. WELCOME Alastair Clegg, CEO 7
We have very clear expectations on how as a team we should behave and how to demonstrate our Values everyday. Our core values are: Compassion We respond with kindness and empathy Accountability We are proactive, take responsibility, do what we say we will, and learn from our mistakes Respect We are inclusive and treat everybody with honesty and decency Excellence Whatever we do, we do it to the best of our ability But what does that mean for you? WHAT CAN YOU EXPECT? 8
It means that... Compassion You can expect us to give you the time and support you need to communicate with us. We will be empathetic and listen carefully to what you have to say. Accountability You can expect us to be open and honest and if we say we will do something we will do it. In the event that we make a mistake we will own up to that and learn from it. Respect You can expect us to knock and pause before entering your room. We will greet you with a smile. Excellence You can expect us to be approachable and communicate clearly with you and check our understanding of what you’re saying. We will focus on your individual needs at the same time as following good IPC (Infection Prevention and Control) practice. WHAT CAN YOU EXPECT? 9
STAFF TRAINING We believe that a planned programme for the training and development of staff is essential to ensure good practice and the provision of a quality service. This is supported by a full introduction to the Company and the training systems during induction. Induction training is the initial training given to new members of staff to orientate them to the job and the workplace, to enable them to fulfil their role and to ensure that they are working safely. We believe in ensuring, wherever possible, that all employees are developed throughout their employment both in terms of technical knowledge and individual progression and an annual ‘training needs analysis’ is conducted during annual appraisals. 10
Tell us how we can improve Swanborough House. We are constantly improving our services, so a few weeks after the resident has been discharged they will be sent a short questionnaire. The responses cannot identify the individual and will not impact on current care, but they will help us improve our service. So please do help us and respond. It is really important to us that residents and families take the time to answer the questions and make comments if they wish. In addition to this due to the nature of long term care we provide we also publish an annual Resident Experience Survey. This is a more structured questionnaire that asks residents to rate the care we provide, our facilities and services. We also have a “Listening to you” scheme whereby residents and visitors can complete a card and put it in the box at Reception. YOUR FEEDBACK MATTERS 11
Swanborough House
13 Thank you for considering Swanborough House. I am Daisy Fernandez, the Registered Manager. I joined the Swanborough House team as a rehabilitation assistant in 2004. I has been the Registered Manager here at Swanborough House since 2015. I have over 18 years’ experience in adult social care, specialising in Neurorehabilitation. The key aims of Swanborough House are to provide rehabilitation for residents with complex needs in order to assist them to achieve their maximum potential for physical, cognitive, social and psychological function, participation in society and quality of living. These guidelines are meant as a tool to assist in the promotion and standardisation of good practice and equity of treatment. INTRODUCTION TO SWANBOROUGH HOUSE Daisy Fernandez Registered Manager Swanborough House DMFernandez
INTRODUCTION Accountability & Responsibility We support and enable staff to deliver effective patient centered rehabilitation. Staff work in well-structured teams and are enabled to practice effectively, through the supporting infrastructure of the organisation and supportive line management. Swanborough House has an appointed therapy team that reports directly to the Service Manager who is responsible for the operational management of the team. The aim is to work jointly & collaboratively in the delivery of rehabilitation services. This includes; Responsibility for the day-to-day delivery of the therapy programmes. Responsibility for the effective delivery of the rehabilitation pathway and process. They ensure compliance of policy, standards & processes. They identify therapy needs within their services, including skill mix, staffing, and training. They are involved in decisions around service improvement and delivery. Training All therapists are skilled and able to deliver high standards of care to the residents. All therapists have mandatory training as required and Swanborough House promotes specialist training through CPD and supervision. 14
INTRODUCTION Professional Accountability All Therapists are registered with the Health Professions Council or other related body this data is held with local HR and updated annually. All Therapists refer to their professional body for their professional Standards, policies and procedures. These are used in conjunction with Renovo standards and policies. All Therapists are aware of the health and community care legislation and how it impacts on delivery of services. All Therapists are required to maintain accurate timely records in accordance with the professional standards and localised guidelines. All Therapists are responsible for identifying their own training needs through the process of appraisal and supervision. All Therapists are aware of the need to update knowledge as part of their continuous professional development & HPC registration. Model of rehabilitation Swanborough House has adopted a bio psychosocial model of rehabilitation as determined by the World Health Organizations ‘International Classification of Function’. This model is a holistic model which encompasses all aspects of a person function including: Body function Body structure Activity Participation Environment 15
Admission from hospital or other transitional service Full assessment to be completed by therapy and nursing team Neuro Rehabilitation 12 week assessment and treatment programme Long term stay / Complex Care / Disability Management Residents can go between pathways INTRODUCTION Rehabilitation Pathway Swanborough House has developed a clear rehabilitation pathway in line with national guidelines and standards for long-term conditions (NSF LTC and NHS Commissioning Board 2013) this ensures that all residents admitted to Renovo services are assessed and treated in a safe and efficient manner. The pathway provides staff, commissioners and residents a clear understanding of what they can expect during their stay. Discharge / Transfer 16
Pre Admission INTRODUCTION Rehabilitation Process Key Therapist to be allocated Resident to be discussed at MDT Key Senior care worker to be allocated Team to consider capacity for rehabilitation / maintenance at Swanborough House and if required apply for DOLs ADMISSION Care plans to be in place within 24 hours of arrival Within the first 24 - 48 hours Moving and handling and Bed rail assessments to be completed. Welcome meeting to be organised by key worker/therapist to be booked with family/friends of resident. Within the first 24 - 48 hours Moving and handling to be completed. Dysphagia guideline to be written if required. Welcome meeting to be organised by key nurse/therapist to be booked with family/friends of patient. First two weeks assessment period: Therapy treatment to begin as appropriate All assessments to be completed as appropriate for each individual: ROM/Tone/Strength Ax Postural Management FIM –FAM Pain questionnaire Bartel Index HADS Week 3: Goals Setting meeting to be held with patient/ family if appropriate. Relevant guidelines/ exercise programmes/ postural management plans to be put in place. All disciplines to attend and goals to be set and recorded Week 10: Reassess all outcomes measures and summary report completed by each relevant discipline. Report must be well written and evidence based. Week 10-12: Case Conference Report completed. Case Conference to be held and attended by all relevant parties. Annual review meeting to be set/agreed. 17
SETTLING IN We are here to look after you and help answer any question you may have. If you are well enough, we will do our best to show you around the service. A member of staff will have explained how to use the call bells by the bedside, and in the bathrooms and toilets. There is space in each room where personal belongings can be stored. We take privacy and dignity very seriously and we will always ensure this is promoted. Our service has both female and male residents, however, each room has its own en-suite facilities. When you are being given therapy, personal care or wish to access the grounds, we will ensure you are appropriately dressed and your privacy and dignity are maintained at all times. 18
Swanborough House has 35 en-suite bedrooms and 2 flats with a communal bathroom and kitchen which are located on ground, first and second floors with lift access. Our therapy and communal rooms are on the ground floor, a games room and TV lounge are located on the 1st floor and a quiet lounge on the 2nd floor. Residents are encouraged to personalise their rooms, according to personal preference. Admission Criteria Swanborough House accommodates residents aged over 18 years of age. Male or Female Diagnosis of Brain injury Stroke Neurological degenerative conditions Physical disabilities Sensory impairments Complex Care needs – Long term placements Every resident has been referred from a healthcare or social work professional and is living with a neurological condition resulting from injury or disease or because of an accident. WHAT WE OFFER 19
HOME COMFORTS Wi-fi Free access to the internet is available to all residents and visitors. To connect to our Wireless network: 1. Go to your wi-fi settings and select “Renovo Guest” 2. Connect 3. If prompted, accept the terms and conditions of use 4. You will then be connected You will not need a password to access the network. If you are prompted to “remember” the network, select Yes for ease of connecting next time you use the device. Watching TV Televisions are provided in each bedroom and we ask that you are considerate to others when watching TV or using other electronic devices as noise may disturb them. 20
We understand how daunting it can be to meet so many new people at first. At the start of every shift a Rehab Assistant who will be looking after you will introduce themselves, so the you always know who to call. Whenever a healthcare professional comes to see you during your stay, they should explain what they are doing or plan to do. WHO’S WHO? 21
22 WHO’S WHO? Daisy Fernadez Registered Manager Kalule Pett Deputy Manager Michelle Lunn Activities Co-ordinator Lorena Salerno Physiotherapist Martin Isitt Occupational Therapist
WHO WEARS WHAT? We all wear identity badges telling you who we are and what we do. Some of us will have our badge on a ribbon round our neck, which can also help you identify people. Please ask if you are unsure about who somebody is. 23
24 ACTIVITIES Everyday there are a range of social activities for you to join in with. The activities range from: Music Quiz Arts & Crafts Gardening Films Board Games Baking Exercise and many many more! During the spring and summer we encourage residents to be outside as much as possible.
25 EVENTS & OUTINGS Throughout the year we host a variety of events and outings which we encourage residents, family, friends and staff to attend. The events vary from Summer BBQ’s to Trips to the circus
26 A wide range of social activities are offered, including cinema trips, outings and accessing services in the community. Residents are also encouraged to explore adult education opportunities offered by local colleges, ranging from supported learning courses such as drama, art and cookery to studying more formal subjects, as appropriate. If appropriate, work placements are sought through support agencies. OUT AND ABOUT
VISITORS We have visiting times so that we can care for all our residents, and residents have a restful and recuperative time. Our visiting times are between 10am and 8pm. However, we understand that people have travel, work, or personal commitments, and cannot always visit during set visiting times. We aim to be flexible. Visitors should not visit if they have coughs or colds or have had an infection, vomiting or diarrhoea in the last two days. Please also ask visitors not to sit on the bed. If young children wish to visit, it is helpful to speak to a member of the care staff to ensure suitable arrangements are in place. We advise that visitors avoid coming in groups. This isn’t because we’re grumpy! It’s so that you get the rest you need and that noise and disruption to other residents is kept to a minimum. If we are busy caring for you, your visitors may be asked to wait before they can see you. This is especially important when you are taking part in a therapy session. 27
MEALS We make appetising, nourishing meals using fresh produce in our on site kitchen. Meal times are: Breakfast - from 8:30am Lunch - from 12:30pm Supper - from 5:00pm Swanborough House caters for all types of diet and any restrictions and ensures that food is nutritious and tasty. Menus are displayed in the dining room on top of each table and a daily choice is displayed on the wall in the dining room. There are several choices for both lunch and dinner. Alternative suggestions are encouraged, as required Tell us If you need help at mealtimes - your Rehab Assistant can help you If you have a dietary requirement that doesn’t appear on the menu If you may need support with shopping or cooking when you go home. 28
LANGUAGE AND COMMUNICATION SUPPORT If you need assistance reading or interpreting the information in this book, please ask a member of staff who will be happy to help. Should you need this book in an alternative format, for example larger font, or in a different language please let us know. 29
Care and Therapy
We have a range of clinical disciplines including: Nursing and Care Staff Occupational Therapists Physiotherapists Speech and Language Therapists We want you to be involved in all decision about your care. We want you to tell us if: You need us to explain something more clearly You need extra help or you are in pain You feel we could involve you more in decisions about your care You have worries about your care You feel there is something we could do differently You would like to try a different therapy OUR CARE 31
ASSESSMENT All residents admitted to Swanborough House undergo a period of assessment by the therapy team. Assessment criteria are guided by the areas identified in the international classification of function, but generally includes areas of, motor function, sensory function, cognition, mood, behaviour, swallow, speech, ADL and participation. Residents admitted are assessed by the therapy team within 2 weeks of admission. Findings of the assessment are recorded on Swanborough House assessment document. Findings are presented at the multi disciplinary team (MDT) meeting where goals are discussed, and future treatment and risk management plans identified. Methods of assessment will vary depending on the discipline and the deficits being assessed. Swanborough House therapy team have access to several standardised and non-standardised tools, which they may select. All assessments are needs lead and no resident is assessed un- necessarily. Consent to assessment is requested prior to each assessment taking place and documented within the resident’s notes. 32
GOAL SETTING During the assessment period therapists working with the residents and families will identify the residents’ long term and short-term rehabilitation goals. Once a resident has been assessed the team will then document the residents’ goals and baseline on function using several standardised tools. Swanborough House have adopted a standardised approach to goal setting, using tools identified by the UK Rehabilitation Outcomes Collaborative (UKROC) program. While UKROC recognize that relevant outcome measures may vary from individual to individual, they recommend that services use one or more of the following key measures: FIM+FAM - A global assessment of functional independence reflecting both physical and psychosocial function (FIM FAM). At Swanborough House this measure is completed on assessment and then monthly thereafter. GAS - Attainment of individual goals for rehabilitation measured by Goal Attainment Scaling (GAS). GAS goals are established following assessment and review dates are set individually with the resident and team and in line with the intensity of treatment to achieve them. 33
GOAL SETTING Discipline specific rehab plan - Individual professions will then establish discipline specific rehabilitation plans that reflect how they are working towards the residents GAS goal. All individual rehabilitation plans should be documented as SMART goals (specific, measurable, achievable, relevant, & time specific) These will form the basis of treatment and should be reviewed fortnightly with the resident and treating team. 34
REVIEWS Commissioner reviews are generally agreed on admission and set at six and 12 weeks. These meetings require the attendance of all relevant clinicians and staff. A report is collated for this meeting, which includes relevant background information, a full assessment of all disciplines that follow the ICF format of function. The report will also include the residents’ rehabilitation goals for the future, including the GAS goals. It includes discipline specific rehab plans, proposed interventions and any outcomes that have been achieved. The review report will also include the FIM FAM splat graph, which will reflect baseline function on admission, current function and future goals. GAS goals are reviewed fortnightly or as required. Reviews of interventions and outcomes are generally carried out with the resident and the treating clinicians. Often goals are reviewed and agreed with the resident & family and then discussed at the MDT meetings where new goals are established. New rehab plans are then agreed. The MDT completes FIM FAMS every four weeks and new goals are determined. Residents will continue to be reviewed quarterly unless they are discharged or moved onto the complex care pathway where FIM FAMs are completed six-monthly or on discharge. 35
REVIEWS Therapy Dependency Score is also part of the UKROC battery and has recently been introduced to Swanborough House Therapy team as a means of documenting the number of hours by discipline that are spent with each resident. The NPTDS/NPCNA is completed retrospectively for each resident on the rehabilitation pathway every month. Both tools will provide more accurate data on therapy hours and care input, providing a more accurate costing method and more transparency for commissioners. 36
If you ever have any questions or concerns about your medication please speak to your Rehab Assistant, Nurse or Doctor at any time. MEDICATION Medication will be discussed with you, please ensure you bring all of your medication with them. When you arrive please ensure all medication is given to a member of staff. It is important for you to tell the doctor about any medicines you are taking, including prescription and over-the-counter medicines as well as any alternative medicines such as herbal remedies. 37
Safety
Your safety and the safety of your family and friends while at Swanborough House is our top priority. This section will explain how we can all be responsible for safeguarding adults. What we and you can do to help prevent infections. There is also a section about Fire Safety at Swanborough House and how in an emergency we would evacuate all residents, visitors and staff. INTRODUCTION 39
SAFEGUARDING is about how adults can get help to stop abuse and neglect from happening. What does Safeguarding Adults mean? Safeguarding means protecting the health, wellbeing and human rights of adults at risk, enabling them to live safely, free from abuse and neglect. It is about people and organisations working together to prevent and reduce both the risks and experience of abuse or neglect. It is also making sure that the adult’s wellbeing is supported and, their views, wishes, feelings and beliefs are respected when agreeing on any action. If you feel that somebody is at immediate risk of harm and that it is an emergency, call 999. Speak to a member of staff or the Registered Manager: Alex Costa, Service Manager - [email protected] Find out more about your local Safeguarding Adults Board online: www.hants.gov.uk/socialcareandhealth/adultsocialcare/safeguard ing SAFEGUARDING ADULTS 40
INFECTION PREVENTION CONTROL PROTECTING YOU We are fully committed to preventing Healthcare Associated Infections and take Infection Prevention and Control very seriously. Infections can be introduced and spread by patients, residents, colleagues and visitors. We see infection prevention and control as an important part of the care we provide. Infections The prevention of infections is important. Infections are caused mainly by bugs or germs (bacteria) or viruses. Most will do us no harm, and some are even essential to maintaining our health and wellbeing. However, when we are unwell or in poor health, we may be much more likely to develop an infection. 41
INFECTION PREVENTION CONTROL PROTECTING YOU Prevention To prevent the spread of infection as much as possible we have a number of measures in place: Thorough care plans for all individuals in our care, that identify any specific risk factors and the measures that the team members need to take Clear IPC policies and procedures, reviewed by our Quality Team Training for all team members, so that they know what measures they need to take Clean, well maintained environments, with dedicated maintenance and housekeeping teams An open culture of reporting infections so that we can learn as a group Regular IPC audits that monitor the effectives of the standards we aim to uphold. 42
Renovo acknowledges that the single most effective method of reducing infections is by good hand hygiene. How should hands be cleaned? There are two main ways to clean hands: Liquid soap and water: this removes germs and is best when hands feel or are visibly dirty, or during an outbreak of diarrhoea and vomiting. Hand sanitiser: our staff have access to these as an alternative to using soap and water for use at the point of care. They are also available at most entrances and exits. INFECTION PREVENTION CONTROL HAND HYGIENE 43
You can help us by telling us of any issues relating to cleanliness or infection control – however small your concern may feel do please let us know so that we can put things right as quickly as possible Please wash your hands each time after you use the toilet and before each meal Please remind team members to wash their hands if you haven’t seen them do this. It may be that they have used a hand sanitizer, but they won’t mind you checking Please let us know if you experience any symptoms of diarrhoea and vomiting Please help us keep the environment clean and clutter free – this helps us keep everything thoroughly clean. There may be times when you may be asked to limit your contact with others, this will always be discussed with you, so do please work with the team to agree how best to follow the relevant guidance. INFECTION PREVENTION CONTROL HOW YOU CAN HELP US 44
We will always Follow the latest infection prevention and control guidance at all times Ensure that your clinical needs are regularly monitored and reviewed Ensure, so far as is practicable that you have a clean, well maintained environment Always involve you in your care and any decisions relating to it. INFECTION PREVENTION CONTROL HOW YOU CAN HELP US 45
Not visiting if unwell, especially if they have experienced diarrhoea or vomiting in the previous 48 hours Washing their hands or using the hand sanitiser on arrival and as they leave Following any guidance given by the team Letting the team know if soap or hand towel dispensers are running low Telling us of any issues relating to cleanliness or infection control – however small If you have any concerns about Infection Prevention Control, in the first instance please speak to a Rehab Assistant, Nurse or Ward Manager. If you require further assistance please contact our IPC Lead, Tracey Wadey, Director of Nursing & Quality. [email protected] INFECTION PREVENTION CONTROL FAMILY, FRIENDS & VISITORS CAN HELP US BY: 46
Fire Safety and Evacuation Planning Swanborough House has all the necessary equipment to evacuate the patients if necessary. We have a Business Continuity Plan developed in line with the EPRR Framework to ensure we have the necessary resources in place to ensure minimal disruption to the service in case of an emergency. Fire tests are completed weekly and Fire drills quarterly. Personal evacuation plans are in place for all patients. FIRE SAFETY AND EPRR 47
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